The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey
Authors: Urisha Singh, Stephen Olivier, Diego Cuadros, Alison Castle, Yumna Moosa, Thando Zulu, Jonathan Alex Edwards, Hae-Young Kim, Resign Gunda, Olivier Koole, Ashmika Surujdeen, Dickman Gareta, Day Munatsi, Tshwaraganang H Modise, Jaco Dreyer, Siyabonga Nxumalo, Theresa K Smit, Greg Ordering-Jespersen, Innocentia B Mpofana, Khadija Khan, Zinzile E L Sikhosana, Sashen Moodley, Yen-Ju Shen, Thandeka Khoza, Ngcebo Mhlongo, Sanah Bucibo, Kennedy Nyamande, Kathy J Baisley, Alison D Grant, Kobus Herbst, Janet Seeley, Deenan Pillay, Willem Hanekom, Thumbi Ndung’u, Mark J Siedner, Frank Tanser, Emily B Wong, Emily B. Wong, Stephen Olivier, Resign Gunda, Olivier Koole, Ashmika Surujdeen, Dickman Gareta, Day Munatsi, Tswaraganang H. Modise, Jaco Dreyer, Siyabonga Nxumalo, Theresa K. Smit, Greg Ording-Jespersen, Innocentia B. Mpofana, Khadija Khan, Zizile E.L. Sikhosana, Sashen Moodley, Yen-Ju Shen, Thandeka Khoza, Ngcebo Mhlongo, Sana Bucibo, Kennedy Nyamande, Kathy J. Baisley, Diego Cuadros, Frank Tanser, Alison D. Grant, Kobus Herbst, Janet Seeley, Willem A. Hanekom, Thumbi Ndung'u, Mark J. Siedner, Deenan Pillay, Mosa Suleman, Jaikrishna Kalideen, Ramesh Jackpersad, Kgaugelo Moropane, Boitsholo Mfolo, Khabonina Malomane, Hlolisile Khumalo, Nompilo Buthelezi, Nozipho Mbonambi, Hloniphile Ngubane, Thokozani Simelane, Khanyisani Buthelezi, Sphiwe Ntuli, Nombuyiselo Zondi, Siboniso Nene, Bongumenzi Ndlovu, Talente Ntimbane, Mbali Mbuyisa, Xolani Mkhize, Melusi Sibiya, Ntombiyenkosi Ntombela, Mandisi Dlamini, Hlobisile Chonco, Hlengiwe Dlamini, Doctar Mlambo, Nonhlahla Mzimela, Zinhle Buthelezi, Zinhle Mthembu, Thokozani Bhengu, Sandile Mtehmbu, Phumelele Mthethwa, Zamashandu Mbatha, Welcome Petros Mthembu, Anele Mkhwanazi, Mandlakayise Sikhali, Phakamani Mkhwanazi, Ntombiyenhlahla Mkhwanazi, Rose Myeni, Fezeka Mfeka, Hlobisile Gumede, Nonceba Mfeka, Ayanda Zungu, Hlobisile Gumede, Nonhlahla Mfekayi, Smangaliso Zulu, Mzamo Buthelezi, Senzeni Mkhwanazi, Mlungisi Dube, Philippa Matthews, Siphephelo Dlamini, Hosea Kambonde, Lindani Mthembu, Seneme Mchunu, Sibahle Gumbi, Tumi Madolo, Thengokwakhe Nkosi, Sibusiso Mkhwanazi, Simbusio Nsibande, Mpumelelo Steto, Sibusiso Mhlongo, Velile Vellem, Pfarelo Tshivase, Jabu Kwinda, Bongani Magwaza, Siyabonga Nsibande, Skhumbuzo Mthombeni, Sphiwe Clement Mthembu, Antony Rapulana, Jade Cousins, Thabile Zondi, Nagavelli Padayachi, Freddy Mabetlela, Simphiwe Ntshangase, Nomfundo Luthuli, Sithembile Ngcobo, Kayleen Brien, Sizwe Ndlela, Nomfundo Ngema, Nokukhanya Ntshakala, Anupa Singh, Rochelle Singh, Logan Pillay, Kandaseelan Chetty, Asthentha Govender, Pamela Ramkalawon, Nondumiso Mabaso, Kimeshree Perumal, Senamile Makhari, Nondumiso Khuluse, Nondumiso Zitha, Hlengiwe Khati, Mbuti Mofokeng, Nomathamsanqa Majozi, Nceba Gqaleni, Hannah Keal, Phumla Ngcobo, Costa Criticos, Raynold Zondo, Dilip Kalyan, Clive Mavimbela, Anand Ramnanan, Sashin Harilall
Journal: The Lancet Global Health (2023)

BackgroundThe convergence of infectious diseases and non-communicable diseases in South Africa is challenging to health systems. In this analysis, we assessed the multimorbidity health needs of individuals and communities in rural KwaZulu-Natal and established a framework to quantify met and unmet health needs for individuals living with infectious and non-communicable diseases.MethodsWe analysed data collected between May 25, 2018, and March 13, 2020, from participants of a large, community-based, cross-sectional multimorbidity survey (Vukuzazi) that offered community-based HIV, hypertension, and diabetes screening to all residents aged 15 years or older in a surveillance area in the uMkhanyakude district in KwaZulu-Natal, South Africa. Data from the Vukuzazi survey were linked with data from demographic and health surveillance surveys with a unique identifier common to both studies. Questionnaires were used to assess the diagnosed health conditions, treatment history, general health, and sociodemographic characteristics of an individual. For each condition (ie, HIV, hypertension, and diabetes), individuals were defined as having no health needs (absence of condition), met health needs (condition that is well controlled), or one or more unmet health needs (including diagnosis, engagement in care, or treatment optimisation). We analysed met and unmet health needs for individual and combined conditions and investigated their geospatial distribution.FindingsOf 18 041 participants who completed the survey (12 229 [67·8%] were female and 5812 [32·2%] were male), 9898 (54·9%) had at least one of the three chronic diseases measured. 4942 (49·9%) of these 9898 individuals had at least one unmet health need (1802 [18·2%] of 9898 needed treatment optimisation, 1282 [13·0%] needed engagement in care, and 1858 [18·8%] needed a diagnosis). Unmet health needs varied by disease; 1617 (93·1%) of 1737 people who screened positive for diabetes, 2681 (58·2%) of 4603 people who screened positive for hypertension, and 1321 (21·7%) of 6096 people who screened positive for HIV had unmet health needs. Geospatially, met health needs for HIV were widely distributed and unmet health needs for all three conditions had specific sites of concentration; all three conditions had an overlapping geographical pattern for the need for diagnosis.InterpretationAlthough people living with HIV predominantly have a well controlled condition, there is a high burden of unmet health needs for people living with hypertension and diabetes. In South Africa, adapting current, widely available HIV care services to integrate non-communicable disease care is of high priority.FundingFogarty International Center and the National Institutes of Health, the Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, the South African Medical Research Council, the South African Population Research Infrastructure Network, and the Wellcome Trust.TranslationFor the isiZulu translation of the abstract see Supplementary Materials section.